spinemap_3d_user_manual_sw_2-0_rev_a_july_2010.pdf
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SpineMap® 3D
User Manual
SpineMap® 3D Navigation Software 2.0
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Introduction/Description of Symbols
This user manual provides general instructions on the use of the
Stryker Navigation System software for image guided computer
assisted orthopaedic surgery.
It contains information on the
planning, navigation, functions
and the general concept of operations for SpineMap 3-D Navigation.
Symbol used in this document
Symbol
W
Description
Marks a warning or caution message
Symbols used in the software
Symbol
Description
Marks an information message
Marks an error message
Marks a warning message
i
User Group
Medical Professional (surgeon/resident, radiologist, nurse/professional caregiver)
For the required safety information and contraindications, please refer to the SpineMap 3-D 2.0 Safety
Information and the Imaging Protocol supplied with the software package, as well as the instructions for use
supplied with the system components.
Refer to
documentation
For detailed instructions and the required safety information related to the Anchoring systems, Anchoring Pins,
Point and Vector Calibration Devices, refer to the instructions for use supplied with these instruments.
For information related to the use of conventional instrumentation, please refer to the user documentation
supplied with each company’s conventional instrumentation.
As with any technical guide, the surgeon should consider the particular condition of the patient and perform the necessary adjustments if required.
Safety and caution should always be utilized before proceeding.
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Table of Contents
1. Set Up System and Log In_ ______________________________________ 4
2. Refer to Imaging Protocol_______________________________________ 5
3. Import Image Sets_____________________________________________ 6
4. Confirm Patient Data_ ________________________________________ 11
5. Planning Features____________________________________________ 12
6. Registration Planning_________________________________________ 41
7. Set Up System_ ______________________________________________ 45
8. Registration_________________________________________________ 47
9. Pedicle Screw Navigation_ _____________________________________ 56
10. Insert Pedicle screw__________________________________________ 64
11. Navigated Minimal Invasive Spine Surgery with Intraoperative
3-D Imaging_______________________________________________ 66
12. Calibrate Conventional Instruments____________________________ 88
13. Navigation Views____________________________________________ 92
14. Additional Navigation and Documentation Tools__________________ 94
15. Part List___________________________________________________ 98
16. Index_ ___________________________________________________ 101
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Set Up System and Log In
1. Set Up System and Log In
1. Plug in the main power cable
of the navigation system.
2. Press the main power button
on the front panel of the navigation system.
3. Enter the user name (navigation) and press the Enter key
or use the left mouse button
to click the OK button.
4. After Application Manager
start up, use the mouse to
select SpineMap 3-D.
Note
The system setup can be completed by the OR support staff
prior to operation.
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Refer to Imaging Protocol
2. Refer to Imaging Protocol
Stryker SpineMap 3-D navigation software requires a CT image
set as a basis for navigation. If
required, additional image sets of
different modalities can be fused
with the CT base images.
ff
For navigation efficiency and
accuracy, follow the recommendations for image acquisition as depicted in the Stryker
SpineMap 3-D Imaging
Protocol.
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Import Image Sets
3. Import Image Sets
Step 1: Select media
Image data can be read from CD,
DVD, Sony/ Maxoptix MO Disk,
USB memory stick or network.
Read image data from media
ff
Insert the media into the
appropriate drive of the navigation system.
The software detects the media
and new image sets automatically.
To start a new case using new
image sets:
ff
Select the Start New Case link
from the Home page.
The Image Sets dialog is activated by the software and the new
image series are automatically
listed.
Read image data from network
The software automatically
detects the image files available
on the network. To retrieve new
image sets from the network:
ff
Select the There are <n> new
image sets ... link from the
Home page.
The Image Sets dialog is activated by the software and the new
image series from the network are
automatically listed.
To preview images:
ff
Select the required image set
from the desired patient listed
in the media content tree.
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Import Image Sets
Step 2: Verify image set
Image set verification enables
you to adjust the contrast and the
surface level of the image set, to
confirm the image orientation
and to select the preferred viewing
direction of images.
Adjust contrast and surface level
1. Click the
icon and open
the Window Width / Level
box.
2. Click the Automatic Adjust
button or use the sliders to
adjust contrast (window level/
width) of the images and
surface level of the 3-D rendering.
Confirm image orientation
ff
Verify that the Image orientation labels are correct on each
of the planes.
WWWarning
Ensure proper image orientation.
Severe accuracy errors result from
incorrect orientation.
If the image orientation label is
incorrect:
1. Move the mouse over the
orientation label requiring
correction.
2. Select the correct orientation
from the pull-down menu.
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Import Image Sets
Step 3: Reduce image set
size (optional)
If necessary, the file size of the
image set to be imported can
be reduced. The RAM indicator
shows the used main memory of
the image set to be imported.
The following procedures help
you to reduce the image set file
size.
Set local import bounding box
The software provides the selection of an import area of the
image set.
ff
Use the mouse to set the
bounding box over the import
area.
The software imports only the
part inside of the bounding box.
Select and deselect single slices
In the Slices view, single slices can
be deselected.
1. Click the Slices tab to switch
to the Slices view.
2. Move the mouse over the
desired slice. The Import
pop-up appears. Deactivate
the checkbox to deselect slice.
Select and deselect all/every even/
every odd/every third slice
In the Slices view, single slices can
be deselected.
1. Click the Slices tab to switch
to the Slices view.
2. Click
to select all/every even/every
odd or every third slice.
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Import Image Sets
Import image set with half resolution
The half resolution feature
enables image sets to be imported
in half resolution.
WWWarning
Reduction of the resolution may
lead to inadequate image quality. Do not reduce the subvolume
or resolution in regions in which
medical indications require the
available image quality. Only
reduce the subvolume or resolution according to established
medical standards.
It is the surgeon’s responsibility to
set the subvolume and resolution.
In case of an unintended reduction of the subvolume or of the
resolution, import the original
scan again.
to convert image set
ff
Click
to half resolution.
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Import Image Sets
Step 4: Import images
To import the selected image set:
1. Select the Import button.
2. Accept the confirmation message:
ff
Proceed to Planning.
ff
Import more image sets.
If required, import additional
image sets for this particular
patient.
ff
Select the desired additional
image set from the media
content tree.
ff
Repeat steps 1 and 2.
If all required image sets are
imported:
ff
Select the Next button to
proceed.
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Confirm Patient Data
4. Confirm Patient Data
Step 1: Confirm patient
data
ff
Confirm patient data listed at
top of the screen.
If patient data needs to be
changed or added:
1. Select the Update Patient
Data link. The Update Patient
Related Data window is
opened.
2. Change or add patient data.
Note
Date of birth is mandatory in
order to ensure unique patient
identification. If required, add the
correct date of birth.
Step 2: Select surgery
direction
1. Select the surgery direction required for the current
patient.
Step 3: Select planning
features
1. Select the planning features
required for the current
patient.
2. Select the Next button to
proceed.
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Planning Features
5. Planning Features
Image Set Correlations
Local Correlation
Overview
SpineMap 3-D software offers a
vast selection of dedicated planning features. The planning
features add functionality to
navigation.
The features available in the Planning dialog depend on the selection made in the Patient dialog.
Segmentation
Planes
Image Set Correlations
Fuse multi-modal images such as
CT and MRI.
Local Correlations
Select a local correlation region
with an adjustable box.
Segmentation
Trajectories
3-D Model
Accentuate anatomical structures of interest such as aberrant
anatomy, soft tissue, tumors, bone
surfaces and vessels.
Planes
Plan and assess resection planes
and the required margins.
Trajectories
Plan and assess surgical trajectories.
3-D Model
Display imported 3-D models
inserted into section and 3-D
images.
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Planning Features
Anatomical System
Anatomical System
Create multiple anatomical systems per series.
Screws
Plan and assess screws that may
be required for reconstruction.
Measurements
Measure distances and angles.
Annotation Points
Screws
Measurements
Annotation Points
Compositions
Mark points of interest and add
personal notes.
Compositions
Create image sets displaying
image modalities, segments and
planned items in a way best suited
for the intended intervention.
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Planning Features
Image set correlations
If two or more image series
for the same patient have been
imported, the image correlation
process can be started.
WWWarning
Different patient positions during
imaging and movement of soft
tissue may result in compromised
image correlation accuracy. To
achieve adequate correlation for
the bony structures of interest,
manual matching correction may
be required.
Step 1: Select series
ff
Select or deselect the pairs of
series to correlate.
Note
Only pairs of image sets can be
correlated.
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Planning Features
Step 2: Start automatic
matching
The complete automatic matching
process may take a few minutes.
For better visualization of the
ongoing process, the two image
series are displayed in different
colors.
ff
Click the Automatic Matching link to start the automatic
matching process.
Note
The matching process can be
terminated manually if no further
alignment takes place.
Step 3: Confirm automatic
matching
ff
Visually verify the suggested
result of the automatic matching process by using well
known landmarks.
If the correlation is acceptable:
ff
Confirm the result by clicking
the checkbox.
If automatic image correlation is
not acceptable:
ff
Perform the Manual matching or activate the Landmark
matching dialog and repeat
the image correlation.
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Planning Features
Local correlations
It is also possible to define correlation regions that are correlated
to the selected navigation base
series.
WWWarning
Different patient positions during
imaging and movement of soft
tissue may result in compromised
image correlation accuracy. To
achieve adequate correlation for
the bony structures of interest,
manual matching correction may
be required by a method such as
landmark matching.
Guidelines for local correlation
regions
For adequate results, follow these
guidelines:
•• Do not include any adjacent
anatomy into the region that
is connected by a joint to the
target anatomy. The position
of the adjacent anatomy may
be different in each image set.
•• Only include bony anatomy in
the target region because the
position of soft tissue may be
different in each image set.
•• The bounding box for defining the local correlation
should be scaled down in all
space directions so that only
a vertebra or the sacrum is
included.
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Planning Features
For adequate correlation results,
a local correlation for a vertebra
should be defined similar to the
following pictures.
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Planning Features
Step 1: Select series
1. Select New Local Correlation.
2. Position the cursor on the
vertebra of interest.
3. Select the base image series for
correlation.
4. Define the correlation region
with the adjustable box.
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Planning Features
5. Select the second image series
for correlation.
6. Adjust the second image series
for correlation.
Note
Parts outside of the correlation region are dimly displayed.
When a local correlation region
is selected, the system shows the
image set on which the region’s
adjustable box has been defined.
Step 2: Start automatic
matching
ff
Click the Automatic Matching link to start the automatic
matching process.
The complete automatic matching
process may take a few minutes.
For better visualization of the
ongoing process, the two image
series are displayed in different
colors.
To check the result during the
matching process:
ff
Click the icon and use the
image box functionality.
Note
The matching process can be
terminated manually if no further
alignment is needed.
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Planning Features
Step 3: Confirm automatic
matching
ff
Visually verify the accuracy
of the automatic matching
process by using well known
landmarks.
If the correlation is accurate:
ff
Confirm the result by clicking
the Confirmed checkbox.
If automatic image correlation is
not satisfactory:
ff
Perform the Manual matching or activate the Landmark
matching dialog and repeat
the image correlation.
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Planning Features
Segmentation
There are two segmentation
workflows.
WWWarning
During navigation, soft tissue
movement may result in erroneous navigational information of
the (segmented) soft tissue anatomy. For each segment, a safety
margin can be defined. During
navigation, the software warns
surgeons visually and audibly
as soon as the navigated tool tip
enters this safety margin.
Step 1: Define segment
type
1. Double-click the image set
that best shows the volume of
interest (for example CT for
bone segmentation and MR
for tumor segmentation).
2. Select New Segment below
the selected image set. Upon
selection, the Segmentation
tool panel is displayed.
ff
Select one of the pre-defined
segment types from the pulldown menu: Bone, Tumor,
Vasculature or User Defined.
The Segmentation tool panel
is expanded.
ff
Select the Automatic Segmentation button.
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Planning Features
Step 2: Start automatic
segmentation
1) Bone Segmentation
1. If required, limit the segmentation space by moving the
boundaries of the rectangular
segmentation box displayed in
the 2-D and 3-D views.
2. Set the crosshair cursor in an
area displaying the bone to be
segmented.
3. Select the Calculate button.
The bone is segmented.
4. Assess the visibility and borders of the segmented bone in
the 2-D and 3-D views.
If the bone is segmented insufficiently:
ff
Lower the Hounsfield threshold to add more cartilage
or thin bone to the bony
structures by moving the
Hounsfield unit slider.
If the bone is satisfactorily segmented:
ff
Click the Finish button to
finalize and save the bone segment.
Note
Automatic bone segmentation
works only with CT image sets.
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Planning Features
2) Tumor/ Vasculature/
User Defined Segmentation
1. If required, limit the segmentation space by moving the
boundaries of the rectangular
segmentation box displayed in
the 2-D and 3-D views.
2. Set the crosshair cursor into
an area showing tissue to segment.
3. Select the Start button. The
structure of interest is segmented.
4. Assess the visibility and borders of the segmented structure in the 2-D and 3-D views.
If the structure of interest is segmented with imperfect borders:
ff
Move the Tolerance slider
until the structure of interest
has reached its optimal visibility.
If the structure of interest is segmented partially and not sufficiently connected to be segmented
in one instance:
ff
Add a new portion to the
structure already segmented
by clicking the More button
and by repeating the Segmentation dialog.
ff
Once the structure is satisfactorily segmented, click the
Finish button to finalize and
save the segment.
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Planning Features
Planes creation
There are two options for resection plane planning: digitizing an
initial axis perpendicular to the
desired resection plane or digitizing three points to define the
desired plane.
Planes are commonly planned for
pelvectomies, sacrectomies and
long bone resections.
For long bones the axis based
resection plane enables easy alignment of perpendicular cutting
planes to the bone shaft.
Step 1: Create new plane
1. Select the image set in which a
plane is to be defined by clicking the image set item in the
patient record tree.
2. Double-click the Planes item
and select New Plane. Upon
selection, the Planes tool
panel is displayed.
Step 2: Select method for
plane creation
ff
Select the desired plane creation method from the pulldown menu: Axis or 3 Points.
The tool panel is expanded for
the selected plane functionality.
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Planning Features
Step 3: Create new planes
1) Axis Method
1. Set the crosshair cursor on
the first point of a virtual axis
that lies perpendicular to the
desired plane (for example
the proximal center point of a
bone shaft).
2. Select the Set Axis Point 1
button to record the position.
3. Set the crosshair cursor on
the second point of the virtual axis perpendicular to the
desired plane (for example the
distal center point of a bone
shaft).
4. Select the Set Axis Point 2
button to record the position.
A plane perpendicular to the
digitized axis is displayed.
5. Select the Plane Oriented tab.
6. Make sure that the plane and
bony intersection mark the
resection line appropriately.
If required:
ff
Adjust the shape (Ellipse/
Rectangle), the size (Size X,
Size Y), the opacity, and the
rotation of the plane using the
radio buttons and the sliders.
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